Alopecia, the medical term for hair loss, can be caused by many factors. These include a genetic predisposition (i.e. male pattern baldness and female pattern baldness), autoimmune disorders (i.e. alopecia areata and discoid lupus), stress, hypothyroidism, malnutrition and vitamin deficiencies, fungal and bacterial infections and certain medications. Alopecia is most commonly due to inherited genes causing male and female pattern baldness. Male pattern baldness manifests as receding hairlines and loss of hair at the crown (“bald spot”) of the head while female pattern baldness manifests as diffuse thinning over the top of the head. It is thought that susceptible individuals have hair follicles that are genetically predisposed to be sensitive to an androgen called dihydrotestosterone (DHT). DHT signals these sensitive hair follicles to stop growing new hair. Treatments for alopecia include oral androgen blockade, topical vasodilators, hair transplant and hair pieces/wigs. For male pattern baldness, the medication finasteride is the most effect treatment to stop hair loss and actually regrow hair.
Finasteride is a 5-alpha -reductase inhibitor, this means that it blocks the conversion of testosterone to DHT, thus lowering the levels of DHT in the bloodstream. The aforementioned genetically sensitive hair follicles are exposed to significantly less DHT and do not stop growing hair. Another effective treatment is minoxidil, which can be used for both male and female
pattern baldness. Minoxidil is a vasodilator (a chemical that causes blood vessels to relax and enlarge) which supports follicular health. Additionally, bimatoprost, a prostaglandin F2 analog, can support hair growth by prolonging the growth phase of the hair follicle. Supplements and antioxidants like zinc and Quecertin, respectively, also promote the health of the hair follicles.
When should treatment be started for alopecia?
The most benefit is achieved when treatment is started when hair loss is first noticed. Also, younger patients typically respond better than older patients. Treatment should continue indefinitely as some of the gains from treatment can be lost upon discontinuing of treatment.